SAR: I suspect you aren't aware of those people who run the HEMS / AA outfits. Most (if not all) have no aviation background. Most are
PR or HR background, some are medical background. The vast majority have little or no business acumen. Before anyone starts - SOME are very savvy, but you could count them on one hand.
What this means is that they are running the arrangement on public sentiment. And if they see the daytime model working [especially if they see the willing volunteers, money pouring in, helicopter companies swooning over themselves to provide turnkey products, councils offering grant aid to set up bases, etc etc; They run hell for leather with it]). And I would say to them: "Why not". It's for a "good cause". Hi tech, public power and no governmental interference is indeed one helluva aphrodisiac. They look up and say: "That's my local air ambulance".
When it comes to extending into night, these 'charity' air ambulance managers see it as a natural extension of their operations. What curbs their enthusiasm of course is the obstacles the CAA throws at them. But they keep trying and as long as the money keeps flowing they come up with solutions (the latest being suitable hems crewpersons / NVD etc). They see it as a growing empire which appears popular, so they don't stop.
What they don't do is a proper business analysis of night HEMS/AA ops. If they did, it simply wouldn't stack up. But the public "appear" to want it, the helicopter lease company want it...emotion wins in the end.
Multiply all the units in England and Wales incomes together and compare it to the life saving returns they produce and you'll soon realise it doen't make any sense at all.
But as long as the public "think" they are in control, they will continue to promote the service in all its fragmented and totally disjointed glory. [Especially when all around them is financially dire - here is one shining light where their hard earned money is literally 'flying high'.
The industry is conducting emotional blackmail..................
We really need a central (independent) audit office which should report and be answerable to the public.